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~-eRMITTEE NAME/ADDRESS pndw4 FxWryNOwL/!ay/nn gDl?+.n.p NA1 <br />YAME :,rr'rtl1S Liif 111 (r (,Ukr..1KA(1(IN <br />ADDRESS N V~ OLiX Oa Cj <br />~~kAli; Cii tllolo C <br />FApu'rv GYPftUS cMPlKt CUIRr'L'KATIUN <br />LOCATIONLkAIv CU bjo~3 FROM <br />Alfh hl('_HAFI w_ 1 toll I,W_ ~,ENCadt Mr_a <br />o1scHMGE fuMlNAnoN s'sTEM lNPDESI Form Approved. <br />MONITORING REPORT IDMRI OMpp NN11 . 2 -0004 <br />/i7-191 L;:~iL >I Oh-iIn IiJ n7lQ Lit-~'.U <br />Approver explre9 OS-8'198 <br />IBER DI GE NUMBER F. ~ FINAL <br />AONITOgINO PERIOD H I ~'~~ <br />DAY EAR MO DAY <br />U I TO ` U U ~ -~ ~ #NOTE: Ra d Inrtruelione baf a com let nM thie form. <br />n.L OCI ~JTI /JA-J9l /36311 7 0 <br />PARAMETER 134rtl On/vl QUANTITY OR LOADING y I4 / QUANTITY OR CONCENTRATION Np, FnEDUENCY SAMPLE <br />l <br />131-371 - /4663/ /54611 51 !6653/ 15461/ <br />EX OF <br />M,LLVSS <br />T~'PE <br />I <br />l AVERAGE MAXIMUM UNITS' UM AVERAGE MAXIMUM UNITS /sJ-sw /6%581 l5&701 <br />f <br />~L.L 11iSE I..T AL SA PLE~ {.*#### ,~##Y,L#M .,~###i## ly <br />I <br />II:I~SLLYtl1 ~ MEASUREMENT ~ . <br />lL.L`!7 1 U 0 r; .PERMIT .'.. ..,+t+iit!'0.~.#.. .;~#~inti!Y. <br />; IR# #t{~4~!).~~:: R~P{~.iR~ <br />`:::. i:F/111:iHkl TiZ1.Y nA:~ <br /> <br /> <br />FrLUENi ~dUSS VALUt REQUIREMENT <br /> <br />.~.:.:,::.:....:.- . <br />, <br />:.. :........ . • r <br />,,. . <br /> <br /> <br /> <br /># . <br />, ,..:.: . <br />:. <br />..:: .. <br /> SAMPLE <br /> MEASUREMENT <br />: <br />~' <br /> ~ <br /> <br /> : <br />~ <br /> ENa'n <br />:1tEQU1 <br />13EM .. <br />~... <br />: <br />~ <br />~ ~ ~ .. <br />~ ~~ <br />. ` .::: <br />:: <br /> . <br />. . <br />.. <br />: <br />: x <br /> SA RLE ~ ,'_ <br /> MEASUREMENT - <br />~~. <br /> ..";FERMI <br />'...:.: <br />.: M .. .. -.: .. ~. <br />... <br />•;' <br /> ~f(EQUjR <br />EMENT .... ..:.. ~ . <br /> <br />.. <br />,:: <br />,.... `..~ <br /> . <br /> <br />..,. <br />r.... ...,,;:: .. <br /> <br />.. .. <br /> <br />-. .. <br /> SAMPLE <br /> MEASUREMENT <br />. .~:7PE•YMIT ~ ~ ... ~ . <br /> R~UUIREMENT <br /> SAMPLE. <br />,_ MEASUflEMfrNT <br /> <br /> HEfiuIkEMENT: : <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> :FiE.~UIh,EMENI`: ~ ~ ~ ~ ~ ~ . <br /> ~. SAMPLE <br /> MEASUREMENT <br /> . <br /> .> <br />- <br />NAMERITLE PRINCIP L EXECUTIVE OFFICER I CERTI <br />AM TA FY t/NOER PENALTY OF LAW THAT 1 HAVE PERSONALLY E%AMI <br />MILfAq WI <br />THE INFORMATION SIIaMITTED HEREIN <br />AND BA NED MD <br />SED ON TELEPHONE DATE <br /> ; <br />TTR <br />MY INQUIRY OF THOSE INDINDUAL9 ,IMMEDIATELY RESPONSIB LE FOR <br />KICII[71-E: IL'IIIIS ~- 06T/JNING THE~INr1FORMATION, I BELEVE THE BUBMITTED INFORM <br />T <br />' ATION IS <br />RE ' <br /> HAT TNf <br />TRUE. ACCCUM7E' AND COMPLETE. 1 <br />AM AWME <br />BMITTN <br />FALSE INFORMATION <br />IN <br />ANT <br />TIES F <br />f ME <br />CLUDING <br />/ <br />87 <br />~ <br />7I2 <br />) <br /> <br />7 <br /> <br />17 <br /> <br />98 <br />L;IIVII.OIlme11tr7I ~]8r18JE!I" , <br />G <br />SIGNI <br />IC <br />PENAL <br />OR SU (97t ~- <br />) <br />. <br /> THEPOSSIBIUTYOFFINEMDIMPRISONMEMT. SEE I6U.S.C.11001M07G BIONATUIIE OF PRINCIPAL EJEECUTNE <br />- U.S.C. 1 131 a. /RFrWei+ ud+r IMw +Yem+ m+Y 1zkW l+w+ 4e ro S IO,DDO R <br />TYPED OR PRINTED +nJ ar T+ninun inOr/enwnt of[wew+xr snmrh+W eY+ral OFFICER OR AUTHORIZED AOENT C <br />ODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRa/erencs s!l sttachmenfs hare/ <br />~cliLtAotc ~L.L[US LIMIT «A1YLL FL;k 1UYnFL4Hl. PrZtl;Il~ cVLNT~ScE I.A. DL N,., IVF FAR i1LdUIi«PiciYfS. Vfl ;. <br />L.NL_a~t p1iAC SAiyPLE ANALYSIS RL-VUIkEJ [F YISLULE SHLtN i5 UdSE~t1cU. ~; h:T :LY SAMPLlwC, [hS ikUCTlUN y'I.L,.aF <br />EPA Faim 3320-1 108.951 Previous editions mey be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.I U U 3 V 1 / 9 b 1 ~ U I - 1 311 PAGE I OF <br />